Oregon state hospitals and cost of care: frequently asked questions (FAQs)
Here are some of the most commonly asked questions about the cost of care at the Oregon State Hospital and the Blue Mountain Recovery Center and how that cost is paid. Each person's circumstances are unique, so if you have detailed questions, please contact the OSH Institutional Revenue office at 503-945-9840.
Are patients liable for the cost of their care?
Yes. Under Oregon law (ORS 179.610 through 179.750), patients admitted to state-operated psychiatric hospitals are liable for the cost of their care. However, patients are expected to pay only what they can afford. The law also says that the hospital must determine whether each patient is able to pay for these services, either now or in the future.
Who determines how much a patient will pay?
Oregon laws and rules (OAR 309-012-0030 through 309-012-0115) say that the amount patients are charged depends on their ability to pay. The hospital's Institutional Revenue Section determines how much each patient can afford to pay. It does this by working with each patient and her or his family or guardian to find out how much money and other assets the patient has, and how much of that is available to pay for care.
For those patients who cannot afford to pay for some or all of their care the state pays the balance through the state General Fund.
What is the total cost of hospital care?
The table shows current cost of care rates:
Blue Mountain Recovery Center
Adult Treatment Services:
Oregon State Hospital
Adult Treatment Services:
Forensic Psychiatric Services:
These rates are based on what it costs the hospitals to provide care for patients in each program. They include room and board, treatment and treatment planning, and nursing. The rates are updated as needed when the hospital's costs change. If a person receives services beyond those included in the average rate, there may be an additional charge for that individual.
Will Medicare, Medicaid or other insurance help pay for services?
Yes, in some cases.
Currently, Medicare Part A (hospital benefit) may be billed for an eligible patient who receives a covered treatment from a Medicare-certified hospital unit, if benefits have not been exhausted. Medicare Part A-certified units are Butterfly 3 at Oregon State Hospital and all of Blue Mountain Recovery Center.
All of Oregon's state hospital programs participate in the Medicare Part B program which covers professional services provided by physicians and licensed clinical psychologists.
Medicaid (Oregon Health Plan) benefits are limited to conditions set by the federal Medicaid program. Under federal rules, Medicaid is available only to persons who are admitted to an inpatient psychiatric hospital with more than 16 beds under the following criteria:
- The patient must be under the age of 21 or 65 and older.
- The patient must be financially eligible for Medicaid.
- The patient must need a certain level of care and receive services from a Medicaid-certified unit. Certified units are Butterfly 3 at Oregon State Hospital and all of Blue Mountain Recovery Center.
Some patients have private or long-term care insurance. The Institutional Revenue Section bills these for any covered services. However, many private insurance plans limit their coverage for services provided by state facilities. For that reason, the patient or their representative should contact the insurance provider as soon as possible after admission to discuss coverage and payment for covered services.
Are patients who are committed to the hospital by the court liable for the cost of their care?
Yes, in most cases, including patients committed to PSRB or found guilty of a crime except for mental disease. There are a few exceptions, such as court-ordered evaluations.
Are parents or family members liable for the cost of care for their child or family member?
No. Under Oregon law, only the patient is liable for the cost of care. However, authorized representatives such as a payee, conservator or trustee may be billed for the cost of the person's care if they are managing or controlling the patient's assets or income.
Will the person's estate be liable for unpaid cost of care?
Yes. The Oregon Health Authority may file a claim against the person's estate for any unpaid cost of care (ORS 179.620 and ORS 179.740).
If a patient cannot afford to pay for care at the time of admission, can charges be assessed at a later date?
Yes. A patient's ability to pay may be re-determined any time during the hospital stay or within 36 months after discharge. In addition, a claim may be filed against a person's estate for any unpaid cost of care.
Are Social Security and veterans benefits considered when determining a patient's ability to pay?
Yes. Social Security and veterans benefits are considered income, the same as income from any other source such as earned income, unearned income and interest.
For information about the Institutional Revenue Section or individual accounts, please call 503-945-9840.